早期气管切开对脑出血开颅术后患者的疗效分析

目的探讨脑出血开颅术后气管切开时机不同对患者的影响。方法 264例脑出血开颅术后患者,根据治疗方案不同分为早期组(148例)和晚期组(116例)。早期组患者存在气管切开指征,主张有气管切开指征时在开颅术后1~3 d内行气管切开手术;晚期组患者主张延长经口气管插管至10 d,根据10 d后患者情况再次评估是否需要气管切开,仍存在手术指征者在术后14 d内行气管切开手术,无手术指征者14 d内拔除经口气管插管。比较两组患者格拉斯哥昏迷指数量表(GCS)评分、临床肺部感染评分、呼吸机使用时长、重症加强护理病房(ICU)入住时长、气管切开率、3个月死亡率、因呼吸问题重返ICU率。结果早期组患者术后7 d的GCS评分(6.57±0.95)分高于晚期组的(6.26±0.75)分,临床肺部感染评分(6.80±0.83)分低于晚期组的(7.08±0.56)分,差异有统计学意义(P<0.05);两组患者术后14 d的GCS评分和临床肺部感染评分比较差异无统计学意义(P>0.05)。早期组患者呼吸机使用时长(72.11±24.39)h和ICU入住时长(285.02±38.53)h均短于晚期组的(174.41±60.43)、(394.31±24.71)h,差异有统计学意义(P<0.05)。晚期组患者气管切开率91.4%低于早期组的100.0%,差异有统计学意义(P<0.05);两组3个月死亡率及因呼吸道问题重返ICU率比较差异均无统计学意义(P>0.05)。两组GCS评分3~5分患者的气管切开率均为100.0%。结论脑出血开颅术后患者延长经口气管插管时间不利于肺部感染的控制,但不会增加对患者预后的负面影响,而且延长经口气管插管时间使部分患者免于气管切开手术,从而减少了更多的创伤性治疗。GCS评分低患者气管切开不可避免,应尽早积极采取气管切开治疗。

Efficacy of early tracheotomy on patients after the craniotomy for cerebral hemorrhage

Objective To discuss the influence of different timing of tracheotomy on patients after the craniotomy for cerebral hemorrhage.Methods 264 patients after the craniotomy for cerebral hemorrhage,were divided into early group(148 cases) and late group(116 cases) according to different treatment schemes.Patients in the early group had the indication of tracheotomy,and they were suggested to receive tracheotomy within 1-3 d after the craniotomy when tracheotomy was indicated;patients in the late group were suggested to receive prolonging orotracheal intubation to 10 d,and whether tracheotomy was needed was re-evaluated according to the patient’s condition after 10 d.For those who still had the indication of surgery,tracheotomy was performed within 14 d after surgery;and for those who had no indication of surgery,orotracheal intubation was removed within 14 d.The Glasgow coma index scale(GCS) score,clinical pulmonary infection score,duration of ventilator use,length of stay in intensive care unit(ICU),tracheotomy rate,3-month mortality and return to ICU due to respiratory problems were compared between the two groups.Results The GCS score of the early group was(6.57±0.95) points,which was higher than(6.26±0.75) points of the late group;the clinical pulmonary infection score of the early group was(6.80±0.83) points,which was lower than(7.08±0.56) points of the late group;and the differences were statistically significant(P<0.05).The differences in GCS score and clinical pulmonary infection score 14 days after the surgery between the two groups were not statistically significant(P>0.05).The early group had a duration of ventilator use of(72.11±24.39) h and length of stay in ICU of(285.02±38.53) h,which were significantly shorter than(174.41±60.43) h and(394.31±24.71) h of the late group,respectively;and the differences were statistically significant(P<0.05).The tracheotomy rate of the late group was 91.4%,which was lower than 100.0% of the early group,and the difference was statistically significant(P<0.05).The differences in the 3-month mortality and return to ICU due to respiratory problems between the two groups were not statistically significant(P>0.05).The tracheotomy rate in patients with GCS score of 3-5 of the two groups was 100.0%.Conclusion For patients after the craniotomy for cerebral hemorrhage,prolonged endotracheal intubation is not conducive to controlling pneumonia,but it does not increase the negative impact of patient prognosis.Some patients with prolonged endotracheal intubation were saved from tracheotomy,so the traumatic treatment is reduced.Tracheotomy is inevitable in patients with low GCS score,and it should be performed as early as possible.